Abstract TP58: Dedicated Stroke Emergency Department APP/Physician Team Improves Door To Provider Times In A Comprehensive Stroke Center

Abstract

Background: Stroke is the leading cause of disability in the US, yet best standard practices for acute stroke care even among premier hospitals in the US varies. The AHA/ASA Get with the Guidelines (GWTG) program set out to create standard metrics to reduce this variation between hospitals. One such measure is the Door to Provider time, with a goal of 10 minutes or less. This goal can be difficult to achieve in large, high volume, Emergency Departments with multiple providers present at a given time. Specialized care has been shown to improve patient outcomes. We set out to create a simple yet effective process improvement of creating a dedicated ED APP/Physician team for each shift to achieve this goal. Methods: Starting in January 2020, a NIHSS trained APP was dedicated to provide assessments of all potential stroke patients upon arrival to the emergency department for a particular shift with a supervising attending ED physician, who also provided backup in situations of concurrent cases. The APP was assigned a phone each shift that can be notified by medical control for any EMS pre arrival stroke notifications and by the triage clinician for ambulatory arrivals. Data was collected starting on January 15 th 2020 for each “Stroke Alert” page and the Door to Provider time was calculated based on documentation in the Emergency Department timeline. From January 15 th 2020 to March 31 st 2022, 2,410 patients were evaluated. Results: The Door to Provider time goal was met greater than 80% of the time. Conclusion: Phase III of Target: Stroke sets challenging time goals for the prompt evaluation and treatment of patients with acute ischemic stroke with an ultimate objective of improved patient outcomes. Through the simple implementation of a dedicated NIHSS trained ED APP and Physician provider for each shift in our high volume, community based Emergency department, we were able to improve and sustain our door to provider times. These process improvement outcomes persisted through the COVID 19 pandemic!